Business Analyst / Job Req 788830863

PRINCIPAL RESPONSIBILITIES:

Under the general supervision of the Director, the Business Analyst performs complex business process and data analysis with internal customers to gather business requirements related to the interoperable exchange of data in structured and unstructured formats for use in identifying technology solutions and supporting system configuration to meet business and regulatory needs. This position will be the liaison between external trading partners alongside internal business and technical teams to provide technical solutions, processes, system configuration and resolutions.

Principal responsibilities include:

Organization expects job performance to be consistent with its vision and mission.  Day-to-day work is focused on these key performance areas. 

1. Collaborate with internal stakeholders to gather, analyze, and document business requirements as they relate to electronic data interchange (EDI) and interoperability processes.

1. Identify and analyze various user problems and make appropriate recommendations. Participate in upgrade/replacement/new implementation projects by tracking activity, resolving issues identified, reporting progress and ensuring solutions meet requirements.

1. Determine operational objectives by studying business functions, gathering information, evaluating input and output requirements and formats. Improve systems by studying current practices and design modifications.

1. Analyze and audit EDI current-use functionality and resulting data for best practices. This may include enrollment, claims, encounters, benefit eligibility and status transaction sets.

1. Recommend technology solutions and manage vendor functionality enhancements to meet the business needs of the AAH Departments. Document those needs and the resulting changes implemented.

1. Ensure that business processes and systems comply with DHCS, DMHC and CMS regulatory requirements.

1. Prepare documentation for audits and regulatory reporting.

1. Maintain detailed and up-to-date documentation of business processes, workflows and standard troubleshooting procedures as they relate to enrollment/eligibility, capitation preparation, member/provider portals.

1. Other duties as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

• Keep abreast of healthcare industry best practices, system capabilities, and managed care regulatory requirements as outlined by California DHCS, DMHC and CMS
• Data entry, analysis, documentation, and reporting.
• Report and presentation development.
• Train staff and consult with managers, IT, and employee users.
• Audit, test, evaluate, and monitor results of EDI and Interoperability processes
• Develop and maintain materials and knowledge bases.
• Teambuilding: Working with internal and external customers to build integrated multi-disciplined teams.
• Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or on a computer.
• Constant sitting and working at a desk.
• Constant data entry using keyboard and/or mouse.
• Frequent use of telephone headset.
• Constant verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.

Number of Employees Supervised:  0

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• Bachelor’s Degree or equivalent professional experience.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Two years of experience in operational healthcare or payer setting required.
• Two years of experience in research, analysis and/or business processes required.
• Three years working knowledge of process functionality and understanding of business platform(s).

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Experience with Medicaid and Medicare regulations published by the California DHCS, DMHC and CMS, and their impact to health plan processes
• Ability to create diagrams such as Use Cases, DFD (Data Flow Diagrams), and others.
• Knowledge of relational database systems, such as SQL or Microsoft.
• Knowledge of the theory, principles, practices and methods of system analysis.
• Must be able to handle competing priorities.
• Ability for critical thinking and communication is required.
• Strong interpersonal skills using clear, concise and professional verbal and written communication skills mandatory, mature judgment, and diplomacy required to interact effectively with a broad spectrum of people, both individually and in groups.
• Ability to prioritize daily work tasks.
• Ability to exercise initiative and judgment and make decisions within the scope of assigned authority.
• Ability to identify sources of problems and arrive at appropriate solutions.
• Understanding of complex systems and how they integrate and impact the entire organization.
• Experience in defining problems, collecting data, establishing facts, and drawing valid conclusions.

SALARY RANGE: $110,094.40 - $165,131.20 Annually

The Alliance is an equal opportunity employer and makes all employment decisions on the basis of merit and business necessity. We strive to have the best-qualified person in every job. The Alliance prohibits unlawful discrimination against any employee or applicant for employment based on race, color, religious creed, sex, gender, transgender status, age, sexual orientation, national origin, ethnicity, citizenship, ancestry, religion, marital status, familial status, status as a victim of domestic violence, assault or stalking, military service/veteran status, physical or mental disability, genetic information, medical condition, employees requesting accommodation of a disability or religious belief, political affiliation or activities, or any other status protected by federal, state, or local laws.

Salary : $110,094 - $165,131